Download Guidelines for Heart Failure in the Adult

Health Care Management Policy and Procedure
Policy Name:
Policy Number:
Effective Date:
Revision Date:
Guidelines for Heart Failure in the Adult
GPD IL – QI 02.05
11/1/01
1/1/10
Review Date: 11/09/2015
BCBSIL Practice Guideline
Next Review Date: 11/2016
Approval
Signature:
Medical Director
IL GDP MMAI, ICP, FHP, MLTSS
Replaces Guidelines for Congestive Heart Failure
Approved QI:11/9/15 CQC: 11/27/12 Approved P&P: 11/28/12
Policy:
The Managed Care Products of Blue Cross Blue Shield of Illinois will operate under BCBSIL Practice
Guidelines for Heart Failure in the Adult (attached).
Purpose/Objectives:
To provide guidelines for the treatment of heart failure in the adult. These guidelines are not intended
either to replace a clinician's judgment or establish a protocol for all patients with this condition. The
final decision regarding medical treatment is made by the physician and the patient.
Guideline:
BCBSIL has adopted the 2009 Focused Update Incorporated into the 2005 American College of
Cardiology/American Heart Association Guidelines for the Diagnosis and Management of Heart
Failure in Adults. The guideline is available at: http://www.acc.org/clinical/statements.htm
Heart failure is defined as a “complex clinical syndrome that can result from any structural or
functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood.” Cardinal
manifestations are dyspnea and fatigue, which may limit exercise tolerance, and fluid retention, which
may lead to pulmonary congestion and peripheral edema.2
The New York Heart Association (NYHA) functional classification gauges the severity of
symptoms in patients with prior or current signs or symptoms of heart failure. A patient’s
functional classification can change frequently, and treatments may not differ significantly
based upon the NYHA classification. Therefore, the AHA/ACC has defined stages of heart
failure to complement the NYHA functional classification, and the ACC/AHA guidelines make
recommendations for four stages of heart failure (HF):
- Stage A: at high risk for HF but without structural heart disease or symptoms of HF
- Stage B: structural heart disease but without signs or symptoms of HF
- Stage C: structural heart disease with prior or current symptoms of HF
- Stage D: refractory HF requiring specialized interventions.
The ACC/AHA guideline notes that Stage A and Stage B are not heart failure but are an attempt to
help healthcare providers identify patients early who have risk factors that predispose toward the
development of HF. For example, patients with conditions such as coronary artery disease,
hypertension or diabetes who do not yet demonstrate impaired left ventricular function, hypertrophy or
geometric chamber distortion are considered Stage A while patients with no symptoms who have left
ventricular hypertrophy and/or impaired left ventricular function are Stage B.
The guideline outlines the characterization of HF as a clinical syndrome, initial and serial clinical
assessment, therapy, treatment of special populations, patients who have concomitant disorders,
end-of-life considerations, and implementation of practice guidelines.
Reference:
A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
Guidelines for Heart Failure in the Adult
2 of 2
Health Care Management Policy and Procedure
1. Jessup M, Abraham WT, Casey DE et al. 2009 Focused update incorporated into the ACC/AHA
2005 guidelines for the diagnosis and management of heart failure in adults: a report of the American
College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
developed in collaboration with the International Society for Heart and Lung Transplantation.
Circulation 2009; 119; 1977-2016.